What We Talk About When We Talk About Cancer

The phrases are familiar: “Fight like a girl!” “We can beat this disease.” “Warriors in pink!” When we talk about cancer, the language of battle is so commonly invoked that you almost don’t register the underlying metaphor unless someone points it out. I have myself, more than once, referred to “kicking cancer’s butt,” and that’s felt reasonably accurate as a description of my attitude. Those rogue cells really aren’t welcome to keep hanging out in my body. In fact, I’m very happy to report that, according to a recent mammogram and ultrasound, they’ve been all but banished, the cancer shrunken to nothing or near it. Woot!

753_breast-cancer-fight-like-a-girlStill, as surgery looms on the horizon, I’ve grown more aware of how the language of aggression, while ostensibly empowering, also pits one against one’s own body in some curious and distressing ways. My sister-in-law Lisa, a survivor, mentioned her discomfort with this language shortly after I was diagnosed. Susan Sontag, in a 1978 essay entitled “Illness as Metaphor,” describes the dilemma: “The controlling metaphors in descriptions of cancer are, in fact, drawn…from the language of warfare; every physician and every attentive patient is familiar with, if perhaps inured to, this military terminology. Thus, cancer cells do not simply multiply; they are ‘invasive’” (714). The language surrounding treatment has a similar inflection: chemotherapy is “chemical warfare, using poisons” that aim to “kill” (715).

The “military metaphor in medicine” extends back to the 1880s in reference to bacteria, but as Sontag points out, “talk of siege and war to describe disease now has, with cancer, a striking literalness and authority. Not only is the clinical course of the disease and its medical treatment thus described, but the disease itself is conceived as the enemy on which society wages war” (716). The catch is that both attack and counterattack aren’t “out there” somewhere; they take place within us.

Breast Cancer Cells
Breast Cancer Cells

After watching the powerful documentary Embrace earlier this week, a film that asks hard questions about why so many women hate their bodies, I was reminded that most of us don’t require a cancer diagnosis to declare war on all or part of ourselves. It’s made me think about the power of the language we use to describe our relationship to this illness, how it affects my ability to make peace with the changes coming to my body. Cancer cells threaten my health, and I want them gone—but there’s no way to separate them entirely from myself, my body, my breast tissue, not without additional losses. Eliminating them has and will bring collateral damage. Suddenly casting those rogue cells as the “enemy” seems more complicated.

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Personally, I’ve also struggled with the language of certainty that frequently emerges in conversations about cancer. While I know people’s intentions are to be supportive, bold declarations like “I know you will beat this” make me uncomfortable, as much or more because of the absolute underneath the “I know you will” as the aggression underscoring “beat.” Positive thinking is a powerful tool for healing, but I’ve found myself unwilling to make such absolute claims.

magic-8-ballThe main reason I resist is that none of us knows the future. That’s a fundamental truth. It isn’t that I don’t want to be healthy and cured—of course I do! But it feels like tempting fate to declare certainty in relation to a particular outcome; I don’t and can’t make predictions. I can only know the present.

And the present is complex and, frankly, not always a big shining ball of positivity. And that’s okay. Sometimes the insistence on “staying positive” feels less like encouragement than a denial of reality. I am thrilled beyond measure that the chemo shrank the mass. And: the bottoms of my feet are still numb with neuropathy, my joints still ache, and I still wear out way too fast to accomplish much of anything. As Buddhist nun Pema Chödrön writes in When Things Fall Apart, suffering is part of life. “Rather than letting our negativity get the better of us, we could acknowledge that right now we feel like a piece of shit and not be squeamish about taking a good look. That’s the compassionate thing to do. That’s the brave thing to do,” she explains. “We can drop the fundamental hope that there is a better ‘me’ who will one day emerge. We can’t just jump over ourselves as if we were not there” (40).

Absolute declarations that I will be cured stake my happiness on a potential event I can’t actually control. We’re so used to privileging “hope” as a good that it’s a bit of a mind-bender to consider a different perspective. But Chödrön points out that focusing on hope casts us into the future and the stories we tell ourselves about it, robbing us, ultimately, of the present moment (40). And since hope and fear go hand in hand, to live driven by hope is also to live with fear (in this case, of recurrence) hovering just underneath the surface. It seems healthier to stay focused on the here and now.

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I do believe language has profound power to shape our experience, that mantras and affirmations can make a real difference. It’s been a challenge to find positive, empowering language beyond battle metaphors and absolutes, but here are some of the phrases I’ve been able to embrace:

This is survivable.

My body can heal.

I will be okay. I am going to be okay.

From a meditation CD a friend sent:

Thank you for teaching me to stop and listen. Thank you for reminding me what is truly important. You can go now. I know I have things to do, gifts to give, purposes to accomplish, and I require a healthy, working body for this.

And perhaps my favorite, from another (salty) survivor:

All I have to do is outlive the f-ing cancer.

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mtnstar_wordsofencouragementIf this is my life (and it is) and if my life (like all our lives) is finite, and if I don’t know its deadline (and none of us does), then how do I want to spend it? Waiting and wishing for a different kind of life, a different kind of day, a “better” one in some projected future? Or do I find a way to accept where I am in the present, since that’s all any of us really knows or has?

At the end of the film Embrace, filmmaker Taryn Brumfitt offers this advice to her daughter: Focus on what your body can do, feel, accomplish, contribute. Don’t waste a minute being at war with your body. Embrace it.

Now we’re talking. Do it today.

The Waiting is the Hardest Part

I remember only a few details from my appointment with the breast surgeon the Tuesday following the MRI. I remember I wore a black t-shirt and a wraparound raw silk skirt I’d bought at a street fair some years back. She wore a simple black sheath. I remember her saying, “We’re going to get the scary stuff out of the way, and then we’re going to forget about it and move ahead.” Then she drew a picture to explain triple negative breast cancer and reassured me that the “Stage 3” was automatically determined by the size of the mass and the local lymph node involvement, that she hadn’t seen anything to make her think there was more going on. I remember shaking uncontrollably. I remember her asking, as she felt my breast, if it were possible the lump had been that hard and pronounced for long, her whispering in my ear as she hugged me good-bye, “We’re going to be hopeful and prayerful. Hopeful and prayerful.”

img_7893Despite her reassurances that there was no immediate evidence of metastasis, I would need a CT scan and a bone scan to be certain the cancer hadn’t progressed beyond the local nodes. I kept shaking, so the staff moved mountains to schedule the tests as soon as possible, three days away, that Friday. Results would likely come after the weekend.

The verb “wait” dates to circa 1200, “to watch with hostile intent, to lie in wait for,” hearkening back to the Old North French waitier, “to watch,” from the Old French gaitier, “watch out, be on one’s guard.” It takes a few centuries before the specific meaning to “endure a period of waiting” is recorded, in 1849.

Steve and I had been waiting to tell family and friends about my diagnosis until we had solid information, a sense of scope and plan. Plus, I knew announcing it to others would make it inescapably real. But it was becoming increasingly impossible to sit on the news. We were scheduled to travel to Georgia in a couple of weeks to help host my parents’ 50th anniversary party, and they’d begun asking questions about the specifics of our visit.

img_7896The noun weight comes from the Old English gewiht, “weighing, weight, downward force of body, heaviness.” The figurative sense of “burden” arrives in the late 14th century.

My parents were celebrating a milestone. I didn’t want to burden them with distraction and worry. But the uncertainties were becoming too heavy to bear alone. I remember crying through the phone call. I remember their calm, steady voices. I remember the sense of relief afterwards.

The use of the phrase “waiting game” is first recorded in 1835. Early on, it referred specifically to a horse-racing strategy for horses whose strength was speed over endurance.

Steve and I had also been looking forward to a trip to Folly Beach. We’d originally planned to leave the Friday the scans were scheduled, but we delayed our departure to Saturday. We’d make an overnight trip back to Roanoke on Monday to see the oncologist, then drive back to South Carolina and finish our week at the shore. It was the best compromise we could manage: we’d have our beach trip, and we’d have a plan.

The two days we spent at the beach not knowing whether the cancer had already spread felt like two centuries.

The evening we arrived, Steve left me to walk on the beach while he went into town to pick up some groceries. I strolled along the edge of the breaking surf, breathing in the salt air, gazing out at a distant horizon that made me feel both seen and insignificant. The sky was dark and heavy with clouds, a storm over the water. I turned around to see the sun beginning to set behind me. As it dropped behind another bank of clouds, it outlined one with a bright halo, its rays splaying dramatically across the sky. Light behind a cloud: was this hope?

img_7909The literal meaning of the verb “weight,” as in “to load with weight” is recorded first in 1747. Its figurative meaning, to load the mind with weight, appeared earlier, as early as the 1640s.

The side effects of chemotherapy are often debilitating and painful. Knowing your body will be permanently altered by surgery is disorienting, even devastating. But the waiting, all the waiting: for appointments, for surgery dates, for results, for reports, for recovery, for any piece of positive news. Ask a cancer patient, and I think many will tell you: all the waiting is the hardest part.

We got the call from the surgeon’s office Monday as we were driving back to Roanoke to meet with the oncologist: my scans were clear. You know your world has flipped upside down and backwards when “stage 3 breast cancer,” a diagnosis that left you shaking in fear just days before, takes on the modifier “only” and suddenly feels like the first good news you’ve had in weeks.

The nurse had tried to call with results late Friday afternoon. I remembered: I’d been on the phone with a delivery company when an unknown local number rang through. I’d started to hang up to answer it, but I couldn’t get a word in with the woman talking furniture. When I checked voice mail afterwards, my phone said it was full, no new messages.

The sense of “wait” meaning to “remain in some place” is from the 14th century.

img_7900-editedGiven a choice, I would not have elected to suffer through those two days of waiting and wondering. But it threw my perspective into sharp focus, gave me a fierce appreciation for the beauty all around me: the gritty give of warm sand under my feet; the spicy bite of fresh shrimp cooked with Old Bay seasoning; the constellation of freckles on my husband’s smiling face. And the sun shining out from behind a darkened cloud.

We’ll wait again, and again. And while we do, my heart breathes every gorgeous moment.


All etymological references are adapted from the Online Etymology Dictionary. Thanks to Tom Petty and the Heartbreakers (via Steve) for the title inspiration.

This Brave New World

Getting a cancer diagnosis is a disorienting experience. It’s as if you’re sitting curled up on the sofa, reading the newest Jennifer Weiner, empathizing with the protagonist as she navigates the everyday joys and foibles of new love and family life, and you turn the page to find yourself suddenly thrust into the middle of a dystopian sci-fi novel. The characters are mostly the same, outside a few additions wearing white coats or colorful scrubs. But the rest of the world has changed. Surrealistic and strange elements—barium smoothies, giant machines, unpronounceable chemicals—appear frequently. The tone, previously light peppered with poignancy, now shifts between darkly serious and comically absurd, every page weighted with philosophical subtext probing what is the meaning of life?

You want more than anything to flip the pages back, to return to the other story. But you can’t.

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The weekend immediately following my Friday biopsy, a lone gunman entered Pulse, a gay nightclub in Orlando, Florida, and shot and killed 49 people and wounded 53 others. That Tuesday, the day after my diagnosis, a toddler was snatched by an alligator in the shallows of a Disney resort lagoon while his parents stood steps away. As I read accounts from those in the club who’d lost loved ones in the shooting, as I imagined the horror and pain of the parents who lost their son, I wondered: how do people who have experienced such suffering, such sudden and horrifying trauma, stand it? How do they go on?

I am slowly discovering: you just do.

I’m not equating anyone’s tragedy with my breast cancer diagnosis; another lesson I’m quickly learning is how individual the process of navigating any form of grief or loss is. And yet all of us who experience a sudden trauma (and many, if not most, of us will) must face that same question, and need to find an answer.

I go on because there aren’t many alternatives. Some who are ravaged by grief take their own lives, but that’s exactly what I don’t want: I don’t want to die yet. That’s exactly why a cancer diagnosis is scary and soul-shifting: the aura of death that hovers around the word. I don’t want to die yet because there are still so many things I want to do. And that eliminates another alternative: curling up and hiding. It’s tempting, and I did lay low in the early days, when we were waiting on more information before we shared the news. It was easier to avoid people than to lie when they asked “How are you?”

But I’ve since felt spurred to action. To reprioritize. To kiss my husband Steve more often. To work actively on a book project. To tell my friends and family as often as I can how grateful I am for their care. Even when it feels like this giant looming thing has pressed the pause button on my life, I am still a newlywed, a wife, a daughter, a friend. I still have stepsons, a dog, cats I love; trails I want to hike, words I wish to write. Uncertainty will be foregrounded in my life for a while, but it’s better, necessary, to keep moving forward. If I found myself in any other threatening landscape—a snowstorm, a swamp—I wouldn’t stop and stand still; that would be uncomfortable, painful, dangerous. I keep moving because hunkering down and staying put won’t make things easier, only harder. I keep moving because whatever hope there is lies somewhere ahead.

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Getting a cancer diagnosis is a disorienting experience. You wake up one morning, head to an appointment for a routine procedure you’ve had done maybe 10 or 15 times—already assured of your good health from a test the week before—and then: an image on a screen, a doctor’s pause, and you know the world you knew is no longer. The story is rewritten in an instant. Perhaps it is a bit like standing on the edge of a peaceful lagoon where an alligator you never imagined could exist appears and snatches away your heart. You wonder: What could I have done differently? Is it my fault? Why me? How can this happen? Yet you know these are pointless questions. The thing has already happened. The world has already changed.

And so you go on. Put one foot in front of the other, and go.